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Revision > Palliative Care > Flashcards

Palliative Care Flashcards

1
Q

Pain ladder

A
  1. simple analgesia
  2. weak opioid
  3. strong opiates
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2
Q

Simple analgesia

A

Paracetamol
NSAIDS
Aspirin

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3
Q

Weak opiates

A

Codeine
Tramadol
Dihydrocodeine

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4
Q

Strong opiates

A

Morphine
Fentanyl patches
Diamorphine
Oxycodone

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5
Q

Bowel obstruction + advanced malignancy

Treatment

A

Palliative colostomy

*NGt initial step for decompression esp if vomiting fecal matter

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6
Q

End stage lung ca + worsening cough +SOB + pleuritic chest pain
Pleural effusion CXR
Treatment>

A

Pleural aspiration - single best management

If extremely ill - not fit for X-ray - consider morphine for SOB

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7
Q

Outpatient on oral morphine - develops side effects

A

Switch to oral oxycodone

Oxycodone - double potency of morphine w/ fewer side effects

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8
Q

Antiemetic for increased intracranial pressure

A

Cyclizine

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9
Q

Medication to help shrink oedema and decrease raised ICP

A

Dexamethasone

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10
Q

Treatment of hypercalcemia secondary to bone mets

A
  1. IV fluids
    +
    IV Bisphosphonates
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11
Q 
Features of hypercalcemia
Neuro
GIT
Renal
CVS
A

Bones stones moans groans

N- lethargy confusion depression
G- constipation nausea vomiting
R - polyuria, polydipsia
C- short QT

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12
Q

Severe bleeding in palliative patient

Management?

A

Midazolam + morphine = subcutaneous

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13
Q

Management of pain due to bone mets

1st & 2nd line

A

1st line- radiotherapy

If fails -
Bisphosphonate + NSAIDS (2nd line)

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14
Q

Management of acute pain due to mets after radiotherapy

A

Morphine sulphate

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15
Q

Management of neuropathic pain

A

Gabapentin
Amitriptyline
Pregabalin
Duloxetine

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16
Q

Management of trigeminal neuralgia

A

Carbamazepine (anticonvulsant)

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17
Q

Gold standard investigation for bone mets

A
  1. MRI*

2. Bone scintigraphy

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18
Q

Sites commonly affected by bone mets

Most common origins

A

SPRSL
Spine >pelvis > rib>skull> long bones

Origins -
Males - prostate, lung
Females - breast,lung

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19
Q

Main dose calculation - oral morphine

A

Sum of all amounts of morphine being received in 24 hrs
__________________________________________________
2

So it can be given 2x a day as a main dose

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20
Q

Oral morphine breakthrough dose calculation

A

Breakthrough dose = additional dose

= 1/6 of total daily dose given PRN 4 hrly
= total main dose / 6

Or

10% of total dose given PRN 4hrly

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21
Q

Terminal patient ask for meds to end life

What do you do?

A

Refer to hospice care

22
Q

What is written in 1a of death certificate?

A

Disease or condition directly leading to death - clear + specific

23
Q

What painkiller should not be given in elderly palliative patients

A

Oral codeine - barely tolerable

**note there is no such thing as SC codeine
It is always oral

24
Q

Side effects of oral codeine develop, what can it be replaced with

A

Buprenorphine patch - optimal
Pick unless the pt is currently in pain as it takes time to work
Or
SC morphine

25
Q

Treatment of capsular pain

A

NSAIDS - ibuprofen, naproxen

26
Q 
Anticipatory meds (only given subcutaneously)
a-For pain and breathlessness
b-nausea and vomiting 
c-anxiety 
d-noisy resp secretions
A

A- morphine sc
B- haloperidol sc
C- midazolam sc
D- hyoscine butylbromide sc

27
Q

Treatment of intractable hiccup due to liver ca

A

Metoclopramide

Others - domperidone , nifedipine

28
Q

What causes the hiccup in liver mets

A

Diaphragmatic irritation = phrenic n irritated = hiccup

29
Q

Treatment of central hiccups

A

Chlorpromazine

30
Q

Anti emetic in renal failure/hypercalcemia/drug induced vomiting

A

1.Haloperidol

Except in Parkinson’s give

2.levomepromazine (second line)

31
Q

Antiemetic in raised ICP

A

Cyclizine

32
Q

Antiemetic in delayed gastric emptying

A

Metoclopramide

33
Q

Antiemetic in chemo/radio

A

Ondansetron

34
Q

Antiemetic for hyperemesis

A

1st line - ZINEs cyclizine, promethazine
2 - IV metoclopramide, ondansetron
3- steroids

35
Q

Antiemetic in Ménière’s disease/ BPPV/ Vestibular neuritis

A

Buccal prochlorperazine

36
Q

How should the prescription of controlled drugs be written

A

Quantity - Figures + words **
Signature - must be handwritten
Age and date of birth of patient - better written, not legally required unless <12yrs

** except oral morphine

37
Q

Step up medication from NSAIDS for gastric ulcers

A

Tramadol - safe to use

38
Q

Noisy respiratory secretion sin late cancer patient

A

antimuscarinics

Sc hyoscine

Others : glycobyrronium bromide sc

39
Q

What delivery method of medication preferred in palliative care

A

Subcutaneous over IV

40
Q

Morphine vs oxycodone

A

Oxycodone is double the potency and has fewer side effects

41
Q

Morphine in treatment of cough

A

Inhibits cough reflex

42
Q

Most appropriate management in pt with cerebral mets - headache + intractable vomiting?

A

High dose dexa - initial treatment to shrink mass and oedema
If GCS = 8 - mannitol (rapid action)
Very low GCS + neuro deficit = urgent craniotomy

43
Q

Conversion of oral dose of morphine to subcutaneous

A

Divide dose by 2

44
Q

Conversion of oral dose of morphine to subcutaneous diamorphine

A

Divide by 3

45
Q

Conversion of oral dose of tramadol to IV morphine

A

Divide dose by 20

46
Q

Management of catastrophic bleeding in palliative care

A

10mg SC midazolam for anxiety

10mg SC morphine sulphate for pain if required

47
Q

SOB in palliative patients treatment

A

Oral morphine

48
Q

Palliative patients with bowel obstruction
Medication ?
Definitive tx?
Initial tx?

A

SC hyoscine butylbromide
Def -palliative stoma
Initial - NGT

49
Q

Legal prescription requirements (4)

A

Patient Name + address
Age + DOB - if <12
Date
Prescriber address

If handwritten - FP10 form
Handwritten signature

50
Q

Cavitary lesion in pt with lung ca
+ low grade fever
Treatment

A

Antibiotics

51
Q

PEG vs NGT feed in palliative care

A

Short term - NGT

Long term - PEG

52
Q

Manage to go leak of PEG after insertion in palliative care

A

Reassure and continue feed

One off leaks may occur as long as there is no infection

Revision (31 decks)

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